Myriad Health & Other Problems Linger 15 Years After 9/11

Emerging research discovers significant health problems continue to affect people exposed to hazards 15 years after the terror attacks of 9/11 and the collapse of the World Trade Center towers.

Dr. Steven Stellman, a professor of epidemiology at Columbia Mailman School of Public Health is co-author of four new studies through the World Trade Center Health Registry. The articles report on outcomes, including cancer, PTSD, acid reflux, asthma, as well as job loss, and early retirement.

Led by scientists at the New York Department of Health and Mental Hygiene, the studies appear in a special 9/11-themed issue of the American Journal of Industrial Medicine.

“A decade and a half after the terrorist attacks of September 11, we have the clearest picture yet on the effects of the events on the health and wellbeing of those most affected,” said Stellman.

While the full extent of cancer risk to the affected population may not be known for years, the new research reveals that, as of 2011, rescue/recovery workers at the World Trade Center site had an 11 percent greater overall cancer risk compared to New York State norms.

Other survivors experienced an eight percent increase. The increases among both groups were most notable for cancers of the prostate and melanoma of the skin.

“On the day of the attacks, people in the vicinity of the site were exposed to intense concentrations of fine particulate dust containing hazardous substances, including many known carcinogens including asbestos and silica,” said Stellman.

“Fumes and dust also penetrated people’s homes and workplaces in lower Manhattan, leading to a lengthy and difficult decontamination process.”

Gastroesophageal reflux disease, or GERD, is one of the most common health conditions reported among persons exposed to the attacks, affecting one in five Registry enrollees in the first two years after 9/11.

In the new research, Stellman and his co-authors find that half of those with early GERD symptoms continued to report persistent symptoms ten years after 9/11, and were more likely to report continuing symptoms if they both had asthma and PTSD during the first three years after 9/11.

Many researchers think that GERD, PTSD, and asthma are all related to to 9/11 exposures and have proposed biological mechanisms by which each of these diseases might exacerbate the others.

However, Stellman said, there is still some uncertainty as to causal relationships since persons with one or two of these conditions are likely to have more medical exams that could lead to increased likelihood of the third diagnosis.

Ten years after the disaster, about seven percent of non-uniformed rescue and recovery workers left their jobs prematurely, about half through early retirement and half due to health-related job loss.

Among non-uniformed rescue/recovery workers age 60 or younger who were still working in 2008, those who endured the most serious 9/11-related health burden were most likely to retire early before reaching the age of 60, and most likely to be unemployed for health reasons.

For the one in five study participants with PTSD, the risk was compounded. Those with a chronic health condition and symptoms of 9/11-related PTSD had double the chances of early retirement, while the odds of health-related job loss increased as much as 10-fold, compared to relatively healthy workers.

The Registry, which opened in 2003, has enrolled 71,000 people who lived, worked, or went to school in the area of the disaster, or were involved in rescue and recovery efforts.

Over the past 14 years, scientists have published nearly 70 papers using Registry data, covering many outcomes including physical and mental health, health care access and utilization, birth outcomes, child and adolescent behavior, quality of life, disaster response, and the added impact of Hurricane Sandy on 9/11 exposed persons.

According to Stellman, the Registry will continue to monitor the population to assess changes in health over time, emphasizing chronic illnesses that may take longer to appear, such as cancer, heart disease, and diabetes, as well as broader questions of health care access and utilization, and quality of life.

“We generously respond to disasters by providing immediate humanitarian aid, but disasters can also have a long lasting effect on many people,” he said. “Fifteen years is not a long time, particularly considering much of the data that we’re reporting ends about three to five years earlier than today. For chronic diseases, much of the story is still to be written.”

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Rick Nauert PhD

Dr. Rick Nauert has over 25 years experience in clinical, administrative and academic healthcare. He is currently an associate professor for Rocky Mountain University of Health Professionals doctoral program in health promotion and wellness. Dr. Nauert began his career as a clinical physical therapist and served as a regional manager for a publicly traded multidisciplinary rehabilitation agency for 12 years. He has masters degrees in health-fitness management and healthcare administration and a doctoral degree from The University of Texas at Austin focused on health care informatics, health administration, health education and health policy. His research efforts included the area of telehealth with a specialty in disease management.